A case report of a high brachial artery bifurcation in relation to clinical significance of artificial arteriovenous fistula

Introduction: The brachial artery starts at the inferior border of teres major and ends by dividing into ulnar and radial arteries in cubital fossa region. The radial artery frequently arises at the level of the neck of the radius and runs along the lateral side of the forearm. Case report: During routine teaching for undergraduate medical student of the upper limb, atypical brachial artery bifurcation giving a high origin of the radial and ulnar arteries was found in the right upper limb of a male cadaver. The bifurcation level was proximal to the interchonylayar line. After that, the ulnar artery descends and gives prominent common interosseous artery at the neck of radius. Conclusion: This case report of vascular variability of the upper limb is to alert vascular radiologists and surgeons as well as nephrologist to prepare a modified surgical intervention of arteriovenous fistula in renal haemodialysis. There is always great vascular variability of the upper limb therefore it is important to be aware of anatomical variation and to avoid iatrogenic fault

Gastro-oesophageal reflux. Part 3:Medical and surgical treatment

Introduction and background: Gastro-oesophageal reflux disease (GORD) is a recurrent, long-term gastrointestinal condition characterised by the abnormal reflux of stomach contents into the oesophagus. Heartburn is the most dominant symptom, which can be life long and can considerably reduce quality of life. The main goals of treatment are to alleviate symptoms and prevent relapses, oesophageal stricture and adenocarcinoma. This paper presents a review comparing the effectiveness of omeprazole with Nissen fundoplication surgery for the treatment of GORD. Methods: A search for English-language studies on adults was conducted using three databases—MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL). Thirteen studies were included in the review. Findings: Nissen fundoplication is more effective in controlling heartburn symptoms, healing oesophagitis and preventing relapses than omeprazole. Quality of life, in terms of productivity and ability to work, is difficult to assess in the omeprazole group and, as a result, a comparison of this aspect is limited. Although fundoplication is expensive in the short term, it is more cost-effective than omeprazole after 8 years. Conclusions: Nurses need to be aware of the effectiveness of omeprazole and fundoplication to provide patients with accurate information, which assists patients in decision making regarding treatment options. </jats:p

Gastro-oesophageal reflux. Part 2:Medical treatment

Introduction and Background: Gastro-oesophageal reflux disease (GORD) is a chronic disease characterised by retrograde movement of stomach contents into the oesophagus. It causes heartburn and oesophagitis and adversely affects quality of life. If left untreated it can lead to oesophageal stricture and carcinoma. The prevalence in Western countries is 30%. This paper presents a comparative review of the effectiveness of Omeprazole with Ranitidine for treatment of GORD. Methods: A search for English language studies on adults was conducted using three databases, MEDLINE, EMBASE and the Cochrane Central Register of RCTs. Thirty relevant studies were included in the review. Findings: Omeprazole is more effective in controlling heartburn symptoms, healing oesophagitis, improving quality of life and preventing relapses than Ranitidine, but takes time to reach therapeutic effect. Ranitidine is more effective at relieving symptoms on an as required basis. Conclusions: Nurses need to be aware of the effectiveness and use of these medications so that patients can make informed treatment choices and develop a greater understanding of the importance of concordance with prescriptions. </jats:sec

Variation of the Lateral Sacral Artery in relation to Sciatic Neuropathy

The lateral sacral artery usually originates from the posterior trunk of the internal iliac artery. The current study of 342 specimens from 171 cadavers (79 male, 92 female) investigated the origin and course of the lateral sacral artery. It was observed to arise from the posterior trunk in 79.1%. Occasionally it originated from the anterior trunk that occurred in 1%. It arose from the sciatic artery in 8.8%, from the superior gluteal artery in 16.8%, and from the inferior gluteal artery in 5.4%. Conversely, the lateral sacral artery is congenital absence in 0.3%. In addition, the lateral sacral artery was single, double, triple, and quadruple in 77.2%, 19.8%, 2.3%, and 0.3%, respectively. Consequently, variability of the lateral sacral artery origin is due to vascular demand as the lateral sacral artery plexus does arise from the earlier trunk development. With variability of the lateral sacral artery origin, there is a variability of the sciatic nerve supply. Knowing the variability of origins, surgeons have to avoid prolonged ligation of the internal iliac artery or its posterior trunk during surgical procedures which may lead to sciatic neuropathy. Therefore, the lateral sacral artery origin, course, and branches are important for clinicians to improve their knowledge and patient management